Endoscopic hand suturing after endoscopic submucosal dissection procedures: a systematic review and meta-analysis

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Aims Gastrointestinal cancer (GC) is the fifth leading malignant tumor as well as the fourth most significant cause of cancer-related death globally. However, the diagnostic rate of early GC (EGC) has been evolving due to the widespread application of endoscopy, especially during regular assessment, and the development of sophisticated endoscopic techniques, such as high-definition endoscopic resection, particularly to endoscopic submucosal dissection (ESD). Despite the global use of ESD as a widely accepted approach for (GC), there are many associated post-operatively complications like perforation, stenosis, bleeding, pneumonia, and others. Endoscopic hand suturing (EHS) is a reliable approach for closing mucosal defects after ESD provides tight intraluminal mucosal closure, resulting in a reduced incidence of adverse events after stomach ESD. We conducted this meta-analysis to appraise the efficacy and safety of EHS for gastrointestinal cancer patients who underwent Gastric ESD. Methods We included studies with a population of patients who undergo EHS after ESD. We searched multiple databases, Medline, Scopus, Web of Science, Cochrane, and Embase, until November 2024. The data were analyzed using R version 4.4.1. Results Nine single-arm observational studies were retrieved through this analysis that met our PICO criteria. Suturing time into the mucosal tissue was reduced among patients who had EHS with [MD:42.16, 95%CI [25.99-58.33], also the closure time with indicated risk ratio for re-bleeding rate following surgery, regardless complete closure rate, sustained closure rate, or partially closure rate, were all reduced with ESH with[MD: 0.95, 95% CI[0.9-0.97]; [MD:0.8, 95%CI[0.74-0.85];[MD:0.13, 95%CI[0.08-0.20] respectively, however, unsustained closure rate did not meet the significance ; [MD:0.01, 95%CI[0-0.07]. The incidence of adverse events such as bleeding, and perforation, following the procedure of EHS all were minimized with [MD: 0.03,) 95%CI [0.02-0.07], [MD:0.01, 95%CI [0-0.04], respectively. Conclusions EHS is a promising future approach for managements of dissatisfied complications following ESD among gastrointestinal patients. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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